Diagnosis and Management of Adult Omental Infarction: 10-Year Case Series

Surgical Complication of Omental Infarction in Ulcerative Colitis Following Laparoscopic Colectomy

Omental infarction is a rare cause of acute abdomen, often mimicking more common abdominal emergencies such as appendicitis and cholecystitis, presenting significant diagnostic challenges. A 47-year-old male with a history of ulcerative colitis underwent laparoscopic total colectomy with end ileostomy. Postoperatively, he developed severe abdominal pain, chills, nausea, and increased abdominal distension. Despite having output from his ileostomy, his symptoms persisted. A CT scan revealed free intraperitoneal air and significant intra-abdominal fluid, indicating potential intra-abdominal injury. Diagnostic laparoscopy identified an infarcted omentum and 850 mL of hemoperitoneum. An omentectomy was performed, and the patient received supportive care postoperatively, leading to gradual improvement in symptoms and recovery. In this case, surgical intervention was required due to severe symptoms, diagnostic uncertainty, and associated hemoperitoneum. While conservative management has been described in stable cases, this approach was not appropriate for our patient. Advanced imaging techniques, particularly CT, remain crucial for identifying omental infarction, but clinical judgment and individual patient factors ultimately guide management decisions.

Primary omental infarction - a benign cause of acute abdomen

Objectives

Omental infarction (OI) is an uncommon cause of acute abdominal pain. A high index of clinical suspicion is required for diagnosis of OI as the incidence is less than 1 %, presenting with abdominal pain. We report primary OI's clinical and radiological profile from a single tertiary care hospital in India.

Methods

In this retrospective cross-sectional study, the electronic medical and radiology records of patients with abdominal pain were reviewed over seven years (2015-2022). Variables were systematically collected and analyzed.

Results

A total of 22 patients diagnosed with primary OI were included in this study. Male preponderance (63.6 %) was noted with a mean age of 47.45 years (SD ± 13.84; range: 18-72 years). Most patients belonged to class I obesity (according to the Asia-Pacific body mass index classification) with a mean BMI of 26.56 kg/m2 (SD ± 3.21 kg/m2). All patients had abdominal pain as the primary symptom, with a mean duration of 8.64 days (SD ± 10.15; range: 1-42 days). The most common locations of pain were the right hypochondrium (27.3 %) and diffuse (27.3 %), followed by the right iliac fossa (18.1 %). Most (95.45 %, n=21/22) patients were treated conservatively, and only one required surgical intervention.

Conclusions

Primary OI is a rare and benign cause of acute abdomen. Obesity is a risk factor but does not correlate with the size or severity of OI. Radiological imaging, like a computed tomography (CT) scan, is essential for diagnosis. A conservative management line should be the first approach in treating primary OI before considering surgical options.

Efficacy and safety of transcatheter arterial embolization of omental artery aneurysm: A single-center experience

BACKGROUND

Omental artery aneurysm (OAA) is an extremely rare visceral artery aneurysm. Ruptured OAAs are associated with a high mortality rate. Transcatheter arterial embolization (TAE) has been used to treat OAA in recent years. However, the risk of omental ischemia due to TAE remains unclear. Therefore, this study aimed to investigate the efficacy and safety of TAE of OAA as a first-line treatment.

METHODS

Fifteen patients with true aneurysms or pseudoaneurysms who underwent OAA-TAE between 1 April 2010 and 31 December 2022 were included in this study. The technical and clinical outcomes, the incidence of omental infarction after TAE as a major complication, OAA-TAE techniques, radiological findings on computed tomography angiography and angiogram, and patient characteristics were evaluated.

RESULTS

Fifteen patients (nine men, six women; age, 69.8 ± 18.59 years) underwent TAE of OAAs (mean aneurysm size of 9.30 ± 6.10 mm) located in the right gastroepiploic (n = 9), left gastroepiploic (n = 1), and epiploic (n = 5) arteries. All patients with ruptured (n = 6) and unruptured (n = 9) OAA successfully underwent TAEs using coils, n-butyl-2-cyanoacrylate, or gelatin sponges. Hepatic artery thrombosis and coil migration were observed during the procedure; however, these adverse events were manageable. Transfusion of red blood cell units (4.66 ± 1.63 units) was required only in cases with ruptured OAAs after TAE. Additional surgery or TAE due to rupture or rerupture of OAA and omental infarction was not required during the postoperative and follow-up periods.

CONCLUSION

The OAA-TAE can effectively treat ruptured and unruptured OAAs, and the risk of omental infarction after OAA-TAE may not be high.

Omental Infarction Mimicking Acute Appendicitis: A Case Report

Acute abdominal pain is a common presentation in emergency departments, often attributed to a myriad of potential causes. Among these, acute appendicitis remains a frequently diagnosed culprit. However, this case report presents a 32-year-old male who arrived at the emergency department with severe right lower quadrant abdominal pain, characterized by localized tenderness and guarding. The initial clinical diagnosis pointed to acute appendicitis. Before surgical intervention, a computed tomography scan was conducted and revealed a focal area of fat stranding, consistent with omental infarction, while the appendix appeared normal. The patient's management involved pain control and supportive care, leading to a complete resolution of abdominal pain at a two-week follow-up. This case emphasizes the significance of including omental infarction in the spectrum of diagnoses for acute abdominal pain, underlining the potential to prevent unnecessary surgical interventions.

Infarto del omento: tratamiento por laparoscopia

Hombre de 34 años, fumador, que consulta por cuadro de dolor en flanco derecho de 24 horas de evolución, sin síntomas acompañantes ni fiebre. Al examen se destaca un abdomen blando, depresible, con dolor a la palpación superficial y profunda del flanco derecho. Los exámenes de laboratorio sin alteraciones. La ecografía abdominal descartó elementos patológicos.

Spontaneous omental infarction: A rare case of acute abdomen

Omental infarction is a rare but a sinister cause of acute abdomen. Preoperative diagnosis is challenging due to its rare nature. It poses nonspecific abdominal signs that can be easily mistaken with other more common intra-abdominal pathologies. We report a case of a 37-year-old male patient presented with right lower quadrant abdominal pain with an elevation of inflammatory markers. His cross-sectional imaging did not a reveal specific diagnosis; therefore, a diagnostic laparoscopy was performed which revealed a non-inflamed appendix and an inflammatory mass formed by the ischemic omentum attached to the ascending colon. Diagnostic laparoscopy and subsequent laparotomy revealed spontaneous omental infarction. The histology of the resected specimen was in keeping with the omental necrosis. This case reflects the importance of considering omental infarction in patients presenting with abdominal pain and raised inflammatory markers. He made an uneventful recovery following surgery.